Skip to main content

Advertisement

SpringerLink
Log in

Histological examination of an eye with endogenous Aspergillus endophthalmitis treated with oral voriconazole: a case report

  • Short Communication
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To report the histological findings of an eye with severe Aspergillus endophthalmitis after oral treatment with voriconazole.

Methods

Case report.

Results

Histopathological examination revealed no fungal elements in choroidal or retinal vessels. The hyphae were mainly restricted to the vitreal side of the preretinal inflammatory infiltrate. Since the treatment with voriconazole had not been completed at the time of enucleation, the clinical course with potential further limitation or regression of the lesion remains unsettled.

Conclusions

Endogenous Aspergillus endophthalmitis is a devastating condition often associated with immunodeficiency. The pathogenesis of this entity implies the primary invasion of choroidal and retinal vessels. The lack of antifungal drugs with high blood–ocular permeability results in an extremely poor visual prognosis. Our histological examination indicates promising activity and ocular penetration of the new antifungal agent voriconazole.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Ascioglu S, Rex JH, de Pauw, et al (2002) Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 34:7–14

    CAS  PubMed  Google Scholar 

  2. Axelrod AJ, Peyman GA, Apple DJ (1973) Toxicity of intravitreal injection of amphotericin B. Am J Ophthalmol 76:578–83

    CAS  PubMed  Google Scholar 

  3. Bodoia RD, Kinyoun JL, Qingli L, Bunt-Milam AH (1989) Aspergillus necrotizing retinis: a clinico-pathologic study and review. Retina 9:226–231

    CAS  PubMed  Google Scholar 

  4. Boldrey EE (1981) Bilateral endogenous Aspergillus endophthalmitis. Retina 1:171–174

    CAS  PubMed  Google Scholar 

  5. Darrell RW (1967) Endogenous Aspergillus uveitis following heart surgery. Arch Ophthalmol 78:354–357

    CAS  PubMed  Google Scholar 

  6. Doft BH, Clarkson JG, Rebell G, Forster RK (1980) Endogenous Aspergillus endophthalmitis in drug abusers. Arch Ophthalmol 98:859–862

    CAS  PubMed  Google Scholar 

  7. Elliott JH, O’Day DM, Gutow GS, Podgorski SF, Akrabawi P (1979) Mycotic endophthalmitis in drug abusers. Am J Ophthalmol 88:66–72

    CAS  PubMed  Google Scholar 

  8. Garbino J, Ondrusova A, Baligvo E, et al (2002) Successful treatment of Paecilomyces lilacinus endophthalmitis with voriconazole. Scand J Infect Dis 34:701–3

    Article  PubMed  Google Scholar 

  9. Graham DA, Kinyoun JL, George DP (1995) Endogenous Aspergillus endophthalmitis after lung transplantation. Am J Ophthalmol 119:107–109

    CAS  PubMed  Google Scholar 

  10. Gross JG (1992) Endogenous Aspergillus-induced endophthalmitis. Retina 12:341–345

    CAS  PubMed  Google Scholar 

  11. Halperin LS, Roseman RL (1988) Successful treatment of a subretinal abscess in an intravenous drug abuser. Arch Ophthalmol 106:1651–1652

    CAS  PubMed  Google Scholar 

  12. Herbrecht R, Denning DW, Patterson TF, et al (2002) Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 347:408–415

    CAS  PubMed  Google Scholar 

  13. Hunt KE, Glasgow BJ (1996) Aspergillus Endophthalmitis. An unrecognised endemic disease in orthotopic liver transplantation. Ophthalmology 103:757–767

    CAS  PubMed  Google Scholar 

  14. Jampol LM, Dyckman S, Maniates V, et al (1988) Retinal and choroidal infarction from Aspergillus: clinical diagnosis and clinicopathologic correlations. Trans Am Ophthalmol Soc 86:422–440

    CAS  PubMed  Google Scholar 

  15. Kalina PH, Campbell JR (1991) Aspergillus terreus endophthalmitis in a patient with chronic lymphocytic leukaemia. Arch Ophthalmol 109:102–103

    CAS  PubMed  Google Scholar 

  16. Katz G, Winchester K, Lam S (1993) Ocular aspergillosis isolated in the anterior chamber. Ophthalmology 100:1815–1818

    CAS  PubMed  Google Scholar 

  17. Laatikainen L, Tuominen M, von Dickhoff K (1992) Treatment of endogenous fungal endophthalmitis with systemic fluconazole with or without vitrectomy [letter]. Am J Ophthalmol 113:205–207

    CAS  PubMed  Google Scholar 

  18. Lederman IR, Madge G (1966) Endogenous intraocular aspergillosis. Arch Ophthalmol 76:233–237

    CAS  PubMed  Google Scholar 

  19. Lin S, Schranz J,Teutsch SM (2001) Aspergillosiscase-fatality rate: systematicreviewoftheliterature. Clin Infect Dis 32:358–366

    CAS  PubMed  Google Scholar 

  20. Luttrull JK, Lee Wan W, Kubak BM, Smith MD, Oster HA (1995) Treatment of ocular fungal infections with oral fluconazole. Am J Ophthalmol 119:477–481

    CAS  PubMed  Google Scholar 

  21. Machetti M, et al (2000) Antigen detection in the diagnosis and management of a patient with probable cerebral aspergillosis treated with voriconazole. Transpl Infect Dis 2:140–4

    Article  CAS  PubMed  Google Scholar 

  22. Mattei D, Mordini N, Lo Nigro C, et al (2002) Voriconazole in the management of invasive aspergillosis in two patients with acute myeloid leukaemia undergoing stem cell transplantation. Bone Marrow Transplant 30:967–70

    Article  CAS  PubMed  Google Scholar 

  23. McDonnell PJ, McDonnell JM, Brown RH, Green WR (1985) Ocular involvement in patients with fungal infections. Ophthalmology 92:706–709

    CAS  PubMed  Google Scholar 

  24. Muijsers RB, Goa KL, Scott LJ (2002) Voriconazole: in the treatment of invasive aspergillosis. Drugs 62:2655–64

    Google Scholar 

  25. Myles MW, Brownstein S, Deschenes J (1997) Clinically unsuspected bilateral Aspergillus endophthalmitis. Can J Ophthalmol 32:182–184

    CAS  PubMed  Google Scholar 

  26. Naidoff MA, Green WR (1975) Endogenous Aspergillus endophthalmitis occurring after kidney transplant. Am J Ophthalmol 79:502–509

    CAS  PubMed  Google Scholar 

  27. Open group discussion (1981) Retina 1:183–185

    Google Scholar 

  28. Paradis AJ, Roberts L (1963) Endogenous ocular aspergillosis. Arch Ophthalmol 69:765–769

    CAS  PubMed  Google Scholar 

  29. Poza G, Montoya J, Redondo C et al (2000) Meningitis caused by Pseudallescheria boydii treated with voriconazole. Clin Infect Dis 30:981–982

    Article  CAS  PubMed  Google Scholar 

  30. Rao NA, Hidayat AA (2001) Endogenous mycotic endophthalmitis: variations in clinical and histopathologic changes in candidiasis compared with aspergillosis. Am J Ophthalmol 132:244–251

    Article  CAS  PubMed  Google Scholar 

  31. Reis A, Sundmacher R, Tintelnot K, et al (2000) Successful treatment of ocular invasive mould infection (fusariosis) with the new antifungal agent voriconazole [letter]. Br J Ophthalmol 84:932–933

    Article  CAS  PubMed  Google Scholar 

  32. Romero AJ, Pogamp PL, Nilsson LG, Wood N (2002) Effect of voriconazole on the pharmacokinetics of cyclosporine in renal transplant patients. Clin Pharmacol Ther 71:226–234

    Article  CAS  PubMed  Google Scholar 

  33. Schwartz S, Milatovic D, Thiel E (1997) Successful treatment of cerebral aspergillosis with a novel triazole (voriconazole) in a patient with acute leukaemia. Br J Haematol 97:663–665

    CAS  Google Scholar 

  34. Smiddy WE (1998) Treatment outcomes of endogenous fungal endophthalmitis. Curr Opin Ophthalmol 9:66–70

    CAS  Google Scholar 

  35. Smith JR (2000) Endogenous Aspergillus endophthalmitis occurring in a child with normal immune function. Eye 14:670–671

    PubMed  Google Scholar 

  36. Überlebensvorteil unter Voriconazole [Survival benefit of voriconazole] (2003) Onkologie Forum Feb: 18–19

    Google Scholar 

  37. Ullmann AJ (2003) Review of the safety, tolerability, and drug interactions of the new antifungal agents caspofungin and voriconazole. Curr Med Res Opin 19:263–271

    Article  CAS  PubMed  Google Scholar 

  38. Weishaar PD, Flynn HW, Murray TG, et al (1998) Endogenous Aspergillus endophthalmitis. Ophthalmology 105:57–65

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Johannes Gutenberg-University Hospital, Mainz, Germany

    Shakhsanam E. Aliyeva, Ulrike B. Kottler & Martine Frising

  2. Third Medical Department, Johannes Gutenberg-University Hospital, Mainz, Germany

    Andrew J. Ullmann

  3. Bürgerhospital Frankfurt am Main, Nibelungenallee 37–41, 60318, Frankfurt am Main, Germany

    Oliver Schwenn

Authors
  1. Shakhsanam E. Aliyeva
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew J. Ullmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ulrike B. Kottler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martine Frising
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Oliver Schwenn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Oliver Schwenn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aliyeva, S.E., Ullmann, A.J., Kottler, U.B. et al. Histological examination of an eye with endogenous Aspergillus endophthalmitis treated with oral voriconazole: a case report. Graefe's Arch Clin Exp Ophthalmol 242, 887–891 (2004). https://doi.org/10.1007/s00417-004-0901-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-004-0901-3

Keywords

Search

Navigation